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Home News First Round of Audit Key Data Shows Overall Percentage of New Patients Subject to MAC Audits at 12%

1ST QUARTER 2016 DATA SUBMISSION PERIOD OPENS APRIL 15

The results are in from the first round of data collection from AAHomecare’s HME Audit Key.  From the initial survey round, covering Fourth Quarter 2105 data, we find that:

  • The percentage of Medicare new patients subject to MAC Prepayment Audit averaged 12% across several categories.  The Hospital Beds, Support Surfaces & Manual Wheelchair category saw the highest audit rate at 22%; at the lower end of the scale, Power Mobility saw a 2% audit rate.
  • 74% of MAC Prepayment Audits of Respiratory Devices and Supplies were paid upon review and the rate for NPWT was even higher at 77%.  At the other end if the spectrum, just 15% of Orthotics and Prosthetics audits were paid upon review.
  • Suppliers appealed 78% of MAC prepayment denials nationwide, underscoring the need for action to reduce the ever-growing backlog of audits awaiting consideration at the ALJ level.

You can see the full first round report here, and view a brief presentationabout them from Kim Brummett, vice president of regulatory affairs with AAHomecare.

These results are a first step in a comprehensive effort to collect data that demonstrates the burdensome nature of audits, in terms of volumes and overturn rates.  Increased participation in the quarterly Audit Key surveys will provide even better data to help us make the case for reform, and will also help us identify new trends and developments in the audit space.
 
The next data submission round, covering the 1st Quarter of 2016, begins on April 15.  Even if you didn’t participate in the initial data submission round, you can still take part in the survey.  You just need one of your organization's NPIs and respective 5-digit zip code to register and get started at HMEAuditKey.org.
 
What kind of information is required?  The Audit Key does not require you to submit data on individual claims, but instead seeks cumulative counts of pre and post payment audits and appeal claim outcomes for your three largest product categories under DME MAC, RAC and SMRC reviews.
 
Your data WILL make a difference!  The HME industry needs reliable and representative data to better demonstrate the burdensome nature of audits, both in terms of volumes and overturn rates.  We must build our capabilities to accurately detail how the industry is being impacted in order to finally secure much-needed reform to the audit process.
 
Register and get started today at HMEAuditKey.org.

The American Association for Homecare represents durable medical equipment providers, manufacturers, and others in the homecare community that serve the medical needs of millions of Americans who require oxygen systems, wheelchairs, medical supplies, inhalation drug therapy, and other medical equipment and services in their homes. Members operate more than 3,000 homecare locations in all 50 states. Visit www.aahomecare.org.

CONTACTS

Gordon Barnes, gordonb@aahomecare.org, 202.372.0759

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